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Changes in career decisions
Career Decisions of Internal Medicine Residents: Considering International Medical Graduates
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Colin P. West, MD, PhD Mayo Clinic College of Medicine, Joseph C. Kolars
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west.colin{at}mayo.edu Colin P. West, et al.
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We appreciate the comments of Dr. Arora and colleagues. We agree that international medical graduates are an important part of the internal medicine residency workforce. As noted by Arora and colleagues, only a very limited literature addresses the development of career decisions of international medical graduates. In our study, we elected to examine factors clearly shown previously to affect career choice, so that other potentially important variables such as medical training site were not evaluated. Our data do allow some insight into how the career plans of international medical graduates may change over the course of training, but we have not yet conducted formal analyses to address this. We agree with Arora and colleagues that this is a worthwhile question to pursue. Because our data do not provide information on why career plans are chosen, the possible influences of factors uniquely affecting international medical graduates cannot be assessed. These questions highlight the fact that selecting a career is a complex process, and issues pertinent to career choice may differ across groups of residents. Our report represents an initial step toward understanding the choices residents make during their training. Further work is necessary to better understand why residents make these choices, and why their choices change during training. Colin P. West, MD, PhD Joseph C. Kolars, MD Mayo Clinic College of Medicine Rochester, MN west.colin@mayo.edu Conflict of Interest:None declared |
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Vineet Arora, MD, MA University of Chicago, Mubashir Khan, MD, Sameer Badlani, MD
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varora{at}medicine.bsd.uchicago.edu Vineet Arora, et al.
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We commend West and colleagues on their examination of the changes in career decisions of internal medicine residents during training especially during this critical period of ongoing discussion regarding internal medicine residency redesign.(1) However, we wish to highlight that the career intentions of international medical graduates-both foreign born and U.S. born, remain overlooked in the analyses presented. Given that more than 40% of internal medicine residency positions are filled by non U.S. seniors, it is especially important to understand the career intentions of this group.(2) While earlier cross-sectional studies of career choice of internal medicine residents elicited during the internal medicine in- training exam suggest that no major differences exist between career intentions of international medical graduates and U.S. medical graduates, understanding how career intentions of international medical graduates change during their internal medicine training remains especially important.(3) As discussed in both the article and accompanying editorial, a likely explanation for a resident switching into general internal medicine or hospital medicine after their PGY2 year would be inability to successfully obtain a position in a competitive subspecialty fellowship, such as gastroenterology or cardiology.(1,4) This is especially true for international foreign-born medical graduates who face limited subspecialty fellowship opportunities for several reasons including increased competition for positions, and current NIH funding restrictions to non U.S. citizens making them ineligible for many fellowship training opportunities.(5) In fact, anecdotes suggest that despite personal preferences, foreign-born international medical graduates must often make career decisions based on the “best case visa scenario.”(2) Because of these reasons, we encourage the authors to consider examination of their data to better understand the changing career intentions of this group, which constitutes a key portion of the internal medicine residency workforce. (1) West CP, Popkave C, Schultz HJ, Weinberger SE, Kolars JC. Changes in Career Decisions of Internal Medicine Residents during Training. Ann Intern Med. 2006;145 (10):774-9. (2) Residents, programs try to finesse complex visa issues. ACP Observer. Available online at: http://doctorsforadults.com/journals/news/july06/visas.htm. Accessed November 29, 2006. (3) Garibaldi RA, Popkave C, Bylsma W. Career plans for trainees in internal medicine residency programs. Acad Med. 2005;80(5):507-12. (4) Sox HC. Career changes in medicine: Part II. Ann Intern Med. 2006;145(10):782-3. (5) McMahon GT. Coming to America--international medical graduates in the United States. N Engl J Med. 2004;350(24):2435-7. Conflict of Interest:None declared |
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